Common law

1- What is common law and how is it created?

Common law is a type of law established by a collection of judges after reviewing the assessments of courts and other similar judicial bodies that have decided on individual cases. Common law is different from statutes which are adopted via a legislative process or principles issued by an executive branch

Before common law can be established, there are several phases of research and examination required of “what the law is” is a similar scenario. Initially the facts must be established. The next step is to find any relevant cases and statutes. This is followed by extracting the analogies, similarities, principles and statements by the many courts on what they considered was important to conclude how the next court is likely to rule on the facts of the present case. Decisions made later and in higher courts generally carry more weight than lower courts and earlier cases. Finally, one has to combine and integrate the information and understand “what the law is.” When all done, the law can be applied to the facts of the present case.

 2- What are statutes?

A formal written representation or publication of a judicial body that governs a country, city or state is known as a statute. In general, a statute either prohibits or commands something or states a policy. Statutes are laws made by the judicial body and often referred to as the “black letter law.” As a basis of law, statutes are a well thought out primary authority. In most cases, statutes are in agreement with the fundamental law of the land.

Guarantee after bariatric surgery

Is there a guarantee that I will lose weight after bariatric surgery?

There is no guarantee. There is a considerable variability in how people respond to surgery. This cannot be predicted beforehand. Just because one obese person lost 100 pounds after surgery does not mean the same will happen to you. Depending on whom you believe and what you read, the numbers of people who fail to respond to bariatric surgery vary from 10%-40%. There are no refunds if you do not respond.My best advice-eat less and walk more. it is cheaper, safer and does work as long as you remain dedicated.

Surgery for dumping syndrome

Do you recommend surgery for dumping syndrome?

Absolutely not. This is not some Mickey Mouse removal of the appendix or repair of a hernia. This is a major undertaking and very few people in the USA are accomplished at it. While all surgeons claim that they can treat dumping syndrome with surgery, the results suck.

The first thing you need is an experienced intestinal surgeon not some mediocre bariatric surgeon. There are various procedure devised to treat dumping syndrome, but there are no long term studies that have shown their effectiveness.

I would avoid surgery and try a drug like octreotide or acarbose. The surgery is also prohibitively expensive and you can rest assured, there will be some type of complication afterwards.

Bariatric surgery and dumping syndrome

I had a gastric bypass done for weight loss and have now developed the dumping syndrome. Is there a medication that will work for this?

To begin with, you are in tough KAKA (that means big S..T). Dumping syndrome is a known complication of gastric bypass surgery. The symptoms can vary in severity but in all cases, make life very unpleasant.

In the past, surgical revision was the only option, but now there are a few drugs that can be tried. Mind you, there is little proof that these drugs work as there are no large clinical trials.

One common diabetic drug that is often prescribed is acarbose. This mild antidiabetic drug is known to interfere with absorption of carbohydrates in the gut, which results in lowering of blood sugars. Acarbose has been shown to decrease symptoms of dumping syndrome.

Now to the negative aspects. The drug prevents absorption of carbohydrates and this leads to fermentation of sugars in the intestine which can cause diarrhea. In addition, the accumulation of carbohydrates leads to excess gas, bad breath and bloating. The majority of people are not able to tolerate the drug because of these adverse effects.

Since now you have very few options, I would try a low dose of this drug-perhaps 25-50 mg and take it from there. Most people see a response at 100-200 mg. Good luck

Heat Therapy for Rheumatoid Arthritis

Is heat therapy effective in patients with rheumatoid joints?

Heat therapy is widely used as complimentary treatment in patients with rheumatoid arthritis. It is claimed to decrease the pain and increase joint mobility. Heat is often administered by a topical heat pack, electric mittens, ultrasound, paraffin wax or going to a spa. There is no difference between any of them when it comes to effectiveness.

You can use a hot water bottle at home and that is as good as a trip to the physical therapist. Most heat therapies at the spa and exercise parlors are nothing more than scams. Physical therapists often recommend exotic devices for heat application but this is primarily designed to swindle the insurance companies or you for more money.

 If you want to obtain benefit from heat, it needs to be applied regularly. When combined with some type of exercise, the results are gratifying. Do not expect miracles because there are at least 30% of rheumatoid patients who see no benefit from heat.

Lefunomide for rheumatoid arthritis

Do you think lefunomide is a safe drug for rheumatoid arthritis?

Lefunomide has been around for 15 years and is sometimes used to treat rheumatoid arthritis; while the drug does work it does have many serious adverse reactions. This has to be discussed between you and the doctor.

Any patient who is on lefunomide must be closely monitored. The drug can seriously damage the liver, cause allergic reactions, suppress the bone marrow and can even cause shortness of breath.

If you can tolerate methotrexate, I would avoid this drug. It is also very expensive and the extra monitoring will mean more visits to the doctor and more costs.

Sulfasalazine is a better option but it is not as potent as lefunomide. Sometimes patients have no choice other than to be prescribed lefunomide.